NeuroRehabilitation 22 (2007) 207–216 207 IOS Press The relation between post concussion symptoms and neurocognitive performance in concussed athletes Vanessa C. Fazio, Mark R. Lovell * , Jamie E. Pardini and Michael W. Collins University of Pittsburgh Medical Center, Department of Orthopaedics, Pittsburgh, PA, USA Abstract. The objective of this study was to examine differences in neurocognitive performance between symptomatic concussed athletes, a group of concussed athletes with no subjective symptoms, and a non-concussed control group of athletes. All concussed athletes were evaluated within one week of injury using the ImPACT computerized test battery. Results indicate that concussed athletes who denied subjective symptoms demonstrated poorer performance than control subjects on all four composite scores of the ImPACT test batters (Verbal Memory, Visual Memory, Reaction Time and Processing Speed However, the concussed but asymptomatic group demonstrated significantly better performance than did the concussed and symptomatic group. Thus, concussed athletes who did not report subjective symptoms were not fully recovered based on neurocognitive testing. This study underscores the importance of neurocognitive testing in the assessment of concussion sequelae and recovery. Keywords: Concussion, mTBI, symptoms 1. Introduction The International Symposium on Concussion in Sports has acknowledged the role of neuropsychologi- cal testing in concussion assessment and return to play considerations [3,32]. The initial guidelines set forth at the 1 st international symposium in Vienna, Austria detailed a “comprehensive systematic approach to con- cussion injury” which included clinical history, evalu- ation, neuropsychological testing, imaging procedures, research methods, management and rehabilitation, pre- vention, education, future directions, and medical/legal considerations [3]. The guidelines advocated the acute use of brief neuropsychological batteries to assess at- tention and memory function with more extensive and specific testing conducted post injury. The Vienna Con- cussion in Sports group (CIS) declared neuropsycho- * Address for correspondence: Mark R. Lovell, Ph.D., ABPN, UPMC Sports Medicine Concussion Program, 3200 S. Water Street, Pittsburgh, PA 15203, USA. Tel.: +1 412 432 3681; E-mail: lovellmr @upmc.edu. logical testing to be “the cornerstone of concussion evaluation” and stated that it “contributes significantly to both the understanding of the injury and the man- agement of the individual” [3, p. 8]. A subsequent statement from the CIS about the value of neuropsychological testing in concussion manage- ment was not as forceful, but, nevertheless, still pro- claimed it to be an “aid to clinical decision making” as part of a comprehensive management system [32]. The follow-up conference in Prague, Czech Republic in 2004 proposed a new classification system for concus- sion and a new, brief, measurement tool for the acute assessment of concussion. However, the importance of neuropsychological testing to determine cognitive recovery in concussion was again underscored [32]. Evidence supporting the use of neurocognitive test- ing has come from numerous studies that have exam- ined its clinical utility. The initial impetus for the uti- lization of neuropsychological testing in sports came from the publication of a large-scale multi-center study by Barth and his colleagues in 1989 [6]. This study used pre-season (baseline) testing as a means of evalu- ating post-injury changes in a group of collegiate ath- ISSN 1053-8135/07/$17.00  2007 – IOS Press and the authors. All rights reserved